NPIMap

Organization Active NPI

Fulton Pharmacy, LLC

Doing business as Whitesells Pharmacy

  • Community/Retail Pharmacy
  • Frederick, MD
National Provider Identifier
1639109473
Registry record updated Jul 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
P04757 Issued in MD
Legal business name
FULTON PHARMACY, LLC
Doing business as
Whitesells Pharmacy
Whitesell Pharmacy
Practice address
236 N Market St
Frederick, MD 21701-5335
Phone
(301) 662-4848
Fax
(301) 620-0668
NPI assigned
Jul 4, 2006
Last updated
Jul 17, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Michael Westbrook
Title
President
Phone
(301) 662-4848

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X P04757 MD Primary
Long Term Care Pharmacy 3336L0003X
Specialty Pharmacy 3336S0011X
Compounding Pharmacy 3336C0004X

Addresses

Primary practice location

236 N Market St
Frederick, MD 21701-5335

Mailing address

236 N Market St
Frederick, MD 21701-5335
Phone (301) 662-4848

Other identifiers 2

IdentifierTypeStateIssuer
419818200MedicaidMD
2033055OtherPK

Other names 2

  • WHITESELLS PHARMACY Doing business as
  • Whitesell Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20091231000391 MD Part B Supplier - Mass Immunization (Roster Biller Only) 5395886071 Practice locations: Frederick, MD
O20100930026536 MD DME Supplier - PharmacyDME Supplier - Medical Supply Company With Registered PharmacistDME Supplier - Medical Supply Company 5395886071 Practice locations: Frederick, MD

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Whitesells Pharmacy4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

236 N Market St
Frederick, MD 21701
Phone (301) 662-4848

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563321600000",
    "number": "1639109473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "236 N MARKET ST",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217015335",
            "telephone_number": "301-662-4848",
            "fax_number": "301-620-0668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "236 N MARKET ST",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217015335",
            "telephone_number": "301-662-4848",
            "fax_number": "301-620-0668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULTON PHARMACY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-04",
        "last_updated": "2019-07-17",
        "status": "A",
        "authorized_official_last_name": "WESTBROOK",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "301-662-4848"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MD",
            "license": "P04757",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "419818200",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2033055",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WHITESELLS PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Whitesell Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Frederick, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.